Effectiveness of Raw, Natural Medical Flower for Treating Insomnia under Naturalistic Conditions.

: We use a mobile software application (app) to measure for the first time, which fundamental characteristics of raw, natural medical flower are associated with changes in perceived insomnia under naturalistic conditions. : Four hundred and nine people with a specified condition of insomnia completed 1056 medical cannabis administration sessions using the Releaf App educational software during which they recorded real-time ratings of self-perceived insomnia severity levels prior to and following consumption, experienced side effects, and product characteristics, including combustion method, cannabis subtypes, and/or major cannabinoid contents of cannabis consumed. Within-user effects of different flower characteristics were modeled using a fixed effects panel regression approach with standard errors clustered at the user level. : Releaf App users showed an average symptom severity reduction of -4.5 points on a 0⁻10 point visual analogue scale (SD = 2.7, d = 2.10, < 0.001). Use of pipes and vaporizers was associated with greater symptom relief and more positive and context-specific side effects as compared to the use of joints, while vaporization was also associated with lower negative effects. Cannabidiol (CBD) was associated with greater statistically significant symptom relief than tetrahydrocannabinol (THC), but the cannabinoid levels generally were not associated with differential side effects. Flower from plants was associated with more negative side effects than flower from or hybrid plant subtypes. : Consumption of medical flower is associated with significant improvements in perceived insomnia with differential effectiveness and side effect profiles, depending on the product characteristics.